Clinical Notes: 2008 Canadian hypertension guidelines

The Canadian Hypertension Education Program has issued the ninth annual update to the Canadian hypertension guidelines. The new edition (2008) promotes home blood pressure (BP) monitoring by patients, since home BP results are better predictors of cardiovascular events than office-based readings.In addition, home BP monitoring can improve BP control, reduce the need for medications and improve medication adherence. Nonadherence to therapy is an important cause of poor BP control. Patient adherence should be assessed at each patient visit.The guidelines stress the need for annual BP measurement in adults with high-normal BP (130–139/85–89), since up to 60% of these patients will develop hypertension within four years. In addition, the risk of cardiovascular disease in hypertensive patients can be reduced by 60% if other cardiovascular risk factors (e.g., unhealthy diet, inactivity, abdominal obesity, dyslipidemia, diabetes) are identified and managed.BP targets and drugs of choice are outlined in the guidelines. As before, thiazide diuretics, beta-blockers (in those < 60 years old), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers or long-acting calcium channel blockers are recommended for initial therapy.In addition, the guidelines now suggest that a combination of two first-line drugs (e.g., diuretic and ACEI) can be considered for the initial treatment of hypertension, when systolic blood pressure is ≥ 20 mm Hg above target or diastolic blood pressure is ≥ 10 mm Hg above target. However, this approach should be used cautiously in patients (e.g., elderly) who are more likely to experience a substantial fall in blood pressure.The guidelines also provide patient instructions for home BP monitoring, lifestyle recommendations, practical advice for reducing sodium intake and helpful Internet resources for patients. The full guidelines and a four-page patient handout are available online.Canadian Hypertension Education Program. 2008 Canadian Hypertension Education Program recommendations: the scientific summary—an annual update. (accessed March 26, 2008).Canadian Hypertension Education Program. Hypertension 2008 public recommendations. (accessed March 26, 2008).

Clinical Notes: 2008 Canadian hypertension guidelines

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